Stark lines are often drawn in American and European literature between graphic novels, which cater primarily to adults, and comics, which despite their broad appeal are perceived as being meant for younger audiences. No such dichotomy exists within the Japanese medium of manga, an expansive art form with works catering to both young and old. Manga broaches a wide range of subjects, including bioethics and the Japanese medical system. For decades poignant and strident critiques of Japanese medicine have emerged as much from mangaka’s pen as from journalists.

An exploration of the intersection of manga and medicine is impossible without considering the work of Osamu Tezuka, the “Godfather of Manga”.1 While better known internationally for his child friendly works including Astro Boy and Kimba the White Lion, Tezuka’s role as a keen observer and vocal critic of medicine is undeniable, especially in his native Japan. As a trained physician himself, though he never practiced medicine, his work as an artist was inextricably linked to his sentiments about Japan’s healthcare system in the postwar era. Through notable works like Ode to Kirihito and Black Jack he castigated the foibles of Japanese medicine as he saw them in his lifetime.

Ode to Kirihito was originally published in Big Comic from 1970 to 1971.2 The manga follows a young doctor, the eponymous Kirihito Sanai, as he seeks a cure for the fictional Minnow disease that disfigures its victims with a canine appearance before killing them. Osmania redoubles his efforts after being infected with Monnow by a jealous colleague who is eager to protect his superior’s theory on the epidemiology of minnow while also stifling a competitor’s promising research career. Increasingly disfigured and alienated from society as the disease progresses, Osanai travels the world in a tireless search for an acceptance and cure for his malady.3 At the heart of Ode to Kirihito is a profound frustration with Japanese medicine’s lionization of academic success and status, even at horrific costs. Sanai maintains an unflinching desire to continue healing others in a world that abhors him, expressing the author’s heartfelt belief that:

“a doctor is not just someone who heals the body, but someone who appreciates the value of life, and inspires others to value it as well.”4

Despite its limited impact in its own time, Ode to Kirihito remains a poignant and inspiring work because of events Tekla could not have predicted, such as the world AIDS crisis. The powerful narrative speaks to the profound isolation and dehumanization imposed on those with poorly understood maladies and the enormous personal and professional risks taken by those who seek to identify with these populations, advocate for them, and ultimately achieve a cure .

Powerful as Ode to Kirihito is, Teuta’s true and enduring legacy as a medical critic is manifested in his far more popular series Black Jack. In this work Tezuka “depicted the physician he would like to have been had he continued with his medical career”.2 Extremely gifted but unlicensed Black Jack serves as a living rebuke of the world in which he lives. Orphaned after his mother is killed by a landmine left over from WWII owing to the negligence and avarice of a greedy land developer, the titular character trains himself as a peerless surgeon and expert in blackmailing the rich. Living off the proceeds from the extraordinary procedures he performs for the often-undeserving, he also works pro bono for the disenfranchised and impoverished.5 Black Jack should not be mistaken for a moral paragon or surgical Robin Hood, though many have made this comparison. His practice raises many bioethical questions of modern medicine. He saves the life of one stable sextuplet with a cranial malformation at the expense of five beautiful but severely premature siblings. He performs a sex-change operation before transsexual was part of the contemporary lexicon.5 As described by Anne Issii: “curiosity — How did he do that? — will invariably turn into incredulity — How could he! — for many medical professionals” while reading Black Jack.5

Gripping story lines, extraordinary anatomical detail, and the protagonist’s moral ambiguity have made Black Jack one of the most popular manga of all time in Japan. Everyone knows him, even far outside the world of comics and his fierce critique of the medical world. It is as if “Batman were about medical corruption.”3 So powerful is Black Jack’s cultural legacy that even his greatest foe, the Japanese Medical establishment, has been forced to concede. In an act of extraordinary irony for a character denied a license on the page as a graduate of a third-tier institution and criticized as “a nonsense story not based on real medical science” by medical elites, the most prestigious medical science society in Japan – The Japanese Association of Medical Sciences- held a Black Jack Exhibition in 2015 at the Kyoto International Manga Museum.6 Perhaps they had little choice, as Black Jack has become synonymous with good health and medical heroism for broad segments of Japanese society.

Tezuka’s enduring legacy explores the intersection of manga and medical critique as it exists today. Modern medical manga, such as Chiho Saito’s Say Hello to Black Jack, owes an enormous debt to this legacy. . Say Hello to Black Jack is a grim window into the corruption and incompetence that pervades the Japanese medical school internship process. As described by historian and manga expert Ada Palmer:

“The subject of the manga is literally that every medical student in Japan starts medical school wanting to be Dr. Black Jack, and then has to face the trauma of discovering that isn’t possible in the real world.”3

Team Medical Dragon by Akira Nagai and Taro Nogizaka assails corruption and petty politics, exposing what the authors refer to as the “sickness of the Japanese medical system”.7Team Medical Dragon, like Black Jack, contrasts maverick doctors who earn their skills working in combat zones and disaster stricken regions, with the hierarchical and research-obsessed Japanese medical establishment that rejects them and treats patients as mere guinea pigs to advance their research and ascend the throne of professorship.8 Issues like the unique struggles of female and parent doctors, health disparities, and conflict of interests are also masterfully portrayed in the series.

It is not only opponents of Japan’s medical establishment that attempt to force improvement and self-reflection through manga. Saijō no meii largely functions as an idealistic recruitment call meant to inspire future Japanese physicians. Despite its general optimism, this series also does not shy away from issues such as dirty hospital politics and the tension between heroic mavericks and a system in which average doctors also deserve a chance to practice. When even the most pro-medicine manga refuse to shy away from the profession’s deep-seated issues, the manga reading audience is not afforded that option either.9

It is not unusual in Japan for a manga on a seemingly niche topic to gain enormous readership, even with subjects as complicated as medical care and health policy. 0 Because of this, people in Japan are intimately aware of the issue of medical corruption to a degree rarely seen in other countries. This engagement and broad-based cognizance has a vast impact on the way the Japanese nation thinks about doctors, healthcare reform, and bioethical issues.

References

Onada N. God of comics: Osamu Tezuka and the creation of post-World War II manga. Jackson, MS. University Press of Mississippi;2009.

O’Luanaigh C. Osamu Tezuka: Father of manga and scourge of the medical establishment. The Guardian. July 21, 2010. Accessed August 01, 2017.

Palmer A. Osamu Tezuka Sage of Medicine. 2012

Palmer A. Sacred Biomedicine and Doctors of the Soul in the Works of Osamu Tezuka. Proceedings of Comics and Medicine: Medical Narrative in Graphic Novels, University of London School for Advanced Study, London.

ADIL MENON, MBE, is currently a medical student at Case Western Reserve School of Medicine. He received his Master of Bioethics degree from Harvard Medical School in 2017. Prior to this he graduated from the University of Chicago with honors in the History, Philosophy, and Social Science of Science and Medicine (HIPS) with thesis work centered on addressing disparities in research participation between different ethnic groups.